Foot and Ankle Surgery

The foot and ankle are mechanically and structurally complex, containing over 20 bones and 30 joints, along with the many muscles, tendons, and ligaments that connect them and allow for movement and function. The foot is divided into 3 regions, including the forefoot, mid-foot, and rear- or hind-foot). When RA affects the joints of the foot, it can make a range of common activities, including basic ambulation (walking), difficult or impossible. This can lead to significant disability.

 

How RA affects the feet

The feet, similar to the hands, are often affected in the early stages of RA. Approximately 13% of RA patients will have foot symptoms as the first signs of RA and 90% of patients will have foot involvement, most typically involving the metatarsophalangeal joints, at some point in the course of RA. Typically, RA symptoms will affect both feet. However, the deformities that appear in each foot may differ due to differences in how weight is distributed between the feet and differences in inflammation.1

In RA, the top of the foot may become red and swollen. Joints at the base of the toes (between the phalanx and metatarsal bones) may become tender, making it painful to walk and causing the patient to shift weight to the heel and bend the toes upward while standing or walking. Joint erosion resulting from chronic inflammation may lead to migration or drift of toes towards the side of foot. Changes to the forefoot that are common in patients with RA include bunions, claw toes, “cock-up” deformity of the fifth toe (the small toe), and pain affecting the ball of the foot. In some patients, the heel may also become painful.2,3

 

Surgery for the feet

If joint symptoms do not respond to medication or other management approaches, surgical interventions may be used. Surgical options include arthrodesis which involves removal of the joint and fusion of two bones into one. Other surgical options (mainly available for the front of the foot) include procedures that correct joint damage (e.g. hammertoes) and spare joints.3

 

Hind-foot

Fusion of the joints of hind-foot is designed to eliminate side-to-side movement, while sparing to some degree up-and-down movement.3

 

Mid-foot

Fusion of mid-foot joints can be used to restore the normal arch of the foot and decrease changes in the shape of the foot that have resulted from damage to joints. The goal is to reduce pain and allow the patient to wear normal shoes. Arthroplasty or joint replacement is available for joints in the outside of the mid-foot and may be used to preserve some degree of mid-foot motion.3

 

Forefoot

Choice of surgical treatment for the toes and ball of the foot to correct deformities, including bunion, claw toes, or hammer toes, depends on the nature and extent of joint damage. If damage is less severe, joint sparing procedures may be used to preserve motion. For the big toe, fusion of joints (arthrodesis) may be used if there is significant cartilage damage. In cases of significant deformity, surgery involving fusion of selected joints, removal of bone, cutting of tendons, and insertion of implants or pins to straighten toes may be used to restore the normal shape of the foot.3

 

How RA affects the ankle

In RA, joints in the ankle may become inflamed and swollen. This inflammation and swelling may eventually lead to nerve damage, resulting in numbness and tingling in the feet.4

 

Surgery for the ankle

If joint symptoms do not respond to medication or other management approaches, surgical interventions may be used. Surgical options include arthrodesis  (fusion of affected joints) and arthroplasty (total ankle replacement). Both of these approaches are effective in reducing pain and improving mobility and function. Fusion of joints involves removal of the joint and fusion of two bones into one. Ankle replacement is typically considered for patients who have already had a fusion of joints or where there is severe involvement of the joints in or near the ankle.3

Written by: Jonathan Simmons | Last reviewed: September 2013.
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